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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Typhoid perforation, limb weakness, paraparesis. Underwent exploratory laparotomy, massage therapy. Septicaemia resolved. Suggestions?

I am an intern physiotherapist and I am currently managing a patient that had typhoid perforation and underwent exploratory laparatomy some weeks to a month back. She had generalized body swelling and associated pain two weeks ago which the doctors said was due to septicaemia. But it resolved after a few days of massage therapy. The problem is that she also has limb weakness, which I initially believed to be related to the swelling and the infection spread. But since that resolved, she still presents with the weakness especially of her lower limbs, which are quite flaccid. The patient is very much conscious and can sit with little help. I've browsed the net and I still haven't found anything to explain the obvious paraparesis the patient is presenting with. Is there any relationship between typhoid perforation and paraparesis? Could the condition, since it was actually treated late, have caused any problem to the spinal network of the lower limbs? Or is this just a normal neurological complication of the disease? Thanks in advance for our input to this and if possible, any reference to an article or webpage that shows more light on this would be highly appreciated.
Thu, 4 Jul 2013
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General & Family Physician 's  Response
Hello Good Evening,

According to your description, patient had typhoid infection, so she underwent to intestinal perforation and had gone through surgery, this indicates that the disease was so serious and complicated with septicemia, perforation, edema etc.

There are lots of complications of typhoid fever, which affects almost every system of the body but less-common, some neurological manifestations events have included spastic paraplegia, peripheral or cranial neuritis, Guillain-Barré syndrome.
Skeletal muscle characteristically shows Zenker degeneration, particularly affecting the abdominal wall and thigh muscles.
Arthritis is very rare and most often affects the hip, knee, or ankle.

So it is a less common but long term neurological and musculo-skeletal complication of natural course of the disease and will take long time to recover.

Regards,

Dr. Naresh Jain

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Typhoid perforation, limb weakness, paraparesis. Underwent exploratory laparotomy, massage therapy. Septicaemia resolved. Suggestions?

Hello Good Evening, According to your description, patient had typhoid infection, so she underwent to intestinal perforation and had gone through surgery, this indicates that the disease was so serious and complicated with septicemia, perforation, edema etc. There are lots of complications of typhoid fever, which affects almost every system of the body but less-common, some neurological manifestations events have included spastic paraplegia, peripheral or cranial neuritis, Guillain-Barré syndrome. Skeletal muscle characteristically shows Zenker degeneration, particularly affecting the abdominal wall and thigh muscles. Arthritis is very rare and most often affects the hip, knee, or ankle. So it is a less common but long term neurological and musculo-skeletal complication of natural course of the disease and will take long time to recover. Regards, Dr. Naresh Jain